Overview
Atrial fibrillation (AFib) is the most common irregular heart rhythm condition. AFib causes erratic, unpredictable electrical activity in your heart’s upper chambers (atria).
During an AFib event, electrical signals make the heart beat rapidly and irregularly. These chaotic heartbeats can cause a variety of symptoms, including difficulty breathing, shortness of breath, and fatigue.
Treatment for AFib often includes a combination of medications and lifestyle changes.
AFib may cause symptoms from time to time. These symptoms can be bothersome. The greatest risk from AFib is stroke or heart failure. People with AFib have an increased risk for these two deadly complications.
Your lifestyle can greatly affect your risk for AFib events, stroke, and heart failure. Here are several lifestyle changes that can help reduce the risk.
More than almost any other factor, what you eat can affect how you feel. Experts such as the American Heart Association (AHA) suggest that people with AFib adopt a diet low in sodium and fat.
A diet designed for people with heart disease can be helpful for people with AFib. Focus on eating a variety of fresh fruits and vegetables. Flavor your food with fresh herbs or vinegars instead of salt. Use lean cuts of meat, and aim to eat fish two to three times per week.
Food can also impact how successful an AFib treatment is. For example, people who use warfarin (Coumadin) to reduce their risk for blood clots must be aware of their vitamin K intake. Vitamin K is a nutrient found in green leafy vegetables, broccoli, and fish. It plays a role in the body’s production of clotting factors.
The consumption of vitamin K-rich foods while taking warfarin can cause unsteady clotting levels. This affects your stroke risk. Be sure to talk to your doctor about the significance of vitamin K intake for your treatment.
Non-vitamin K oral anticoagulants (NOACs) are now recommended over warfarin in part because vitamin K doesn’t reduce the effects of NOACs like warfarin does. Talk to your doctor about which medications might be right for you.
If you’ve been diagnosed with AFib, it’s time to quit smoking cigarettes. Nicotine, the addictive chemical in cigarettes, is a stimulant. Stimulants increase your heart rate and can possibly cause an AFib event.
Additionally, quitting is good for your overall health. Smoking is a risk factor for several chronic diseases, including coronary artery disease (CAD) and cancer. Many people trying to quit have success with over-the-counter smoking cessation patches and gums.
If those aren’t successful, talk with your doctor about other medications or therapies. The sooner you’re able to stop smoking, the better.
A glass of wine may help you relax after a long day, but it could cause serious problems for your heart if you have AFib. Studies show that alcohol can trigger an AFib episode. Heavy drinkers and people who binge drink are more likely to experience an AFib episode.
But it’s not just large amounts of alcohol that can put you at risk. A Canadian study found that moderate drinking could cause an AFib episode. For men, this would mean having 1 to 21 drinks in a week. For women, it would mean 1 to 14 drinks in a week.
Caffeine is a stimulant found in many foods and drinks including coffee, soda, and chocolate. For people with AFib, caffeine may pose a threat since stimulants can increase your heart rate. AFib is sensitive to changes in heart rate, so something that changes your natural rhythm could cause an AFib episode.
But this doesn’t mean you have to cut caffeine completely. Drinking too much caffeine could trigger AFib, but a cup of coffee is likely fine for most people. Talk with your doctor about your risks.
Exercise is important for both your overall health and the health of your heart. Regular physical activity can prevent a number of conditions and diseases that complicate AFib, including obesity, diabetes, heart disease, and possibly cancer.
Exercise is good for your mind, too. For some people, dealing with AFib can cause great anxiety and fear. Exercise can help naturally improve your mood and prevent emotional issues.
Rest and relaxation are beneficial to your body and your mind. Stress and anxiety can cause dramatic physical and chemical changes, especially to your heart. Proper relaxation can help heal the damage.
If you make time on your calendar for business meetings and appointments, you need to make time for fun too. Give yourself a better work-life balance, and your heart will thank you for it.
Treatment for AFib isn’t a one-size-fits-all plan. People with AFib should create their own treatment plan with their doctor. This plan will probably include both medications and lifestyle changes.
Finding the best treatment plan may take some time. Your doctor may try several types of treatments with you before finding one that best helps prevent AFib symptoms. In time, however, you’ll be able to prevent some of your risk factors and reduce the likelihood of AFib-related complications.
Atrial fibrillation (Afib or AF) is a type of irregular heart rhythm (arrhythmia). Arrhythmias are due to electrical signal disturbances of the heart. Afib is the most common arrhythmia, affecting approximately 200,000 Canadians. The risk of developing atrial fibrillation increases with age and with other risk factors such as diabetes, high blood pressure and underlying heart disease. The main complications of atrial fibrillation are stroke and heart failure.
Atrial fibrillation affects the top two chambers of the heart (the atria). Arrhythmias can also occur in the two chambers below the atria (the ventricles), which tend to be more serious than arrhythmias affecting the atria.
The atria are the heart's collecting chambers. Regular electrical signals help push blood efficiently from the atria into the pumping chambers (the ventricles). From the ventricles, blood is pumped to the rest of the body. In Afib, the electrical signals are fast, irregular and disorganized, and the heart may not pump as efficiently.
Atrial fibrillation can cause your heart to beat very quickly, sometimes more than 150 beats per minute. A faster than normal heartbeat is known as tachycardia.
Most people with Afib lead active, normal lives with treatment, but untreated it can interfere with your quality of life. Talk to your doctor if you have Afib and continue to feel unwell.
One-fourth of all strokes after age 40 are caused by Afib.
Untreated atrial fibrillation puts you at a higher risk for stroke and heart failure.
People with atrial fibrillation have 3 to 5 times greater risk for ischemic stroke. During Afib, the atria contract chaotically. Because the atria aren’t moving blood properly, blood pools and gets stuck in the grooves of the heart. Blood clots may form, which could get pumped to the brain. An ischemic stroke is caused when blood flow to the brain is interrupted by a clot in a blood vessel in the brain. It is estimated that one-fourth of all strokes after age 40 are caused by Afib.
The risk of stroke depends on several other risk factors including the presence of heart failure, having high blood pressure or diabetes, being over 40 years of age, or having had a previous stroke or a mini-stroke (TIA).
Studies show that long-term use of the blood thinner warfarin in patients with Afib can reduce the risk of stroke by 70 to 80%.
Atrial fibrillation can also lead to heart failure. Heart failure is a condition in which your heart can't circulate enough blood to meet your body's needs. Afib’s irregular, fast heart beat leads to ineffective pumping of the blood which – especially if not controlled – may weaken the heart.
Paroxysmal: temporary episodes that come and go. They start suddenly and then the heart returns to a normal beat on its own without medical assistance, usually within 24 hours.
Persistent: episodes that last longer than seven days. Usually treatment is needed to return the heart to a normal rhythm.
Permanent: the irregular heart rhythm lasts for more than a year despite medications and other treatments. Some people with permanent Afib do not feel any symptoms or require medications.
Common causes of Afib include:
In many cases, the cause of atrial fibrillation is not known.
If you develop Afib before the age of 60 without any structural heart disease, you may have idiopathic (or lone) atrial fibrillation. Researchers have identified a handful of genes that predispose families to idiopathic Afib. It is also possible for young people without Afib in their family to develop the disease.
I had been diagnosed with atrial fibrillation but I did not realize it was a risk factor for stroke. We need to get more information out about personal risk factors and increase awareness of the signs of stroke.
Lynne Stacey
Some people with Afib may feel fine and not know they have the condition until it is found in a routine test called an electrocardiogram. Other people have symptoms. The symptoms affect people in different ways. If you are experiencing any of these Afib symptoms, visit your doctor.
- palpitations – this might feel like your heart is racing, beating irregularly or flip-flopping in your chest.
- feeling very tired/ having no energy – you may feel short of breath or weak with the slightest physical effort.
- chest discomfort
- feeling light-headed or dizzy
- sweating
- feeling anxious
- trouble concentrating
If you are experiencing chest discomfort or other signs of a heart attack, call 9-1-1 or your local emergency number immediately.
Ask your doctor to check your pulse on a regular basis.
Your treatment will be based on your risks, medical profile, needs, preferences and how much symptoms are interfering with your quality of life.
There are two general treatment strategies – rate control and rhythm control. Your doctor will determine which strategy is best for you based on your symptoms and other factors.
- Rate control Almost every patient with atrial fibrillation will be prescribed a medication to slow their heart rate. For some people, this type of medication is enough to control their symptoms.
- Rhythm control This is an attempt to prevent an irregular heartbeat by restoring and maintaining a normal, regular heartbeat. The first step is medication to prevent the Afib from occurring. Some patients may also require electrical cardioversion. This is a controlled electric shock to the heart to restore a normal rhythm. On rare occasions medications and electrical cardioversion do not work. You may be referred to a specialist and considered for an electrophysiology study and catheter ablation to stop the Afib from recurring.
Medications
The medications used for atrial fibrillation are:
Here are some tips for managing your medications.
Surgeries and other procedures
- Cardioversion therapy Electrical pulses are sent through paddles to the heart to jolt the heart back into normal rhythm. Cardioversion is similar to defibrillation, but uses much lower levels of electricity.
- Electrophysiology studies (EPS) and Catheter ablation Some people with Afib – who do not respond to medications or electrical cardioversion – require an EPS to stop Afib from recurring. EPS testing is used to locate the site of the irregular electrical impulses in the heart. Catheter ablation is then performed to destroy – through tiny burns – the electrically chaotic heart tissue. Ablation creates scars in the heart that stabilize the electrical short circuits.
- Implantable pacemaker is a surgically implanted device that helps regulate heart rate and rhythm by using electrical pulses to prompt the heart to beat at a normal rhythm.
Most patients go on to lead good quality lives. Don’t be scared. Afib is a problem, but it is treatable and controllable.
Dr. Paul Dorian, Cardiologist St. Michael's Hospital, Toronto
Lifestyle
You can lower your risk of developing other heart diseases and stroke by knowing and controlling your blood pressure, diabetes and blood cholesterol. It’s also important to lead a healthy lifestyle.
Talk to your doctor about the lifestyle changes that will benefit you the most.
Living with atrial fibrillation
- Pay attention to your emotional reaction.
It’s normal to feel worried or afraid after a diagnosis of heart disease. Find someone you can turn to for emotional support like a family member, friend, doctor, mental health worker or support group. Talking about your challenges and feelings could be an important part of your journey to recovery.• The recovery and support section is full of practical advice and tips to support you on your recovery journey.
• Find peer support resources here.
• Join Heart & Stroke’s Community of Survivors or Care Supporters’ Community support groups.
• Sign up for the Heart & Stroke recovery newsletter. Get the latest research news and information, with tips and strategies to help you manage your recovery. - Don’t be afraid to exercise. Sometimes people feel they can’t exercise with atrial fibrillation because they don’t feel well or they are afraid. As long as you are feeling well, you can still exercise.
If you have atrial fibrillation, staying physically active will have a positive impact on your overall health. Talk to your doctor before you become more physically active.
- Manage your blood pressure.
High blood pressure is a risk factor for stroke and other heart-related problems, in addition to being a risk factor for atrial fibrillation. - Visit your doctor regularly to have your atrial fibrillation monitored.
- Cardiac rehabilitation is a personalized program of exercise, education and counselling to help you recover from heart disease and reduce your risk of having other heart problems in the future. Talk to your doctor about how to find a program in your area or contact your public health department or hospital. The Canadian Association of Cardiac Rehabilitation also has a cardiac rehabilitation program directory to help you find a program in your community.